Feline triaditis

• Cats are different - anatomical differences


  Concurrent biliary tract disease, pancreatitis and IBD/ (F)CE more common in cats.

  • Pancreatic duct joins the CBD before reaching the duodenum in most cats.
  • Triaditis or multiple organ inflammatory disease.
• Cats are different - metabolic differences

  Ineffective glucoronidation pathway reduced the ability to metabolise drugs and toxins.

  • More susceptible to toxic damage.
  • Sensitive to many hepatotoxic drugs.

  Cats must eat and they must eat high quality protein:

  • In cats hepatic gluconeogenesis relies on protein.
  • Protein calorie malnutrition occurs if they are fed a low protein diet.

  Cats rely on dietary taurine and arginine.
• Pathological process in the cats liver

  1. Neutrophilic cholangitis - infiltration of neutrophils. Is a septic inflammatory disease.
  2. Lymphocytic cholangitis - infiltration of lymphocytes. This is usually a chronic disease, suspected to be immune mediated.
  3. Hepatic lipidosis - is the result of peripheral fat mobilisation, overwhelming the liver. Severe cholestasis is caused by compression secondary to hepatocyte triglyceride vacuolar distension. Underlying diseases can include: DM, pancreatitis, IBD/FCE; anything that stops food intake.
• Neutrophilic cholangitis

  Appropriate antibiotic - 4-6 weeks, amoxicillin is a good 1st choice or if no diagnostics.

  Ursodeoxycholic acid - choleretic effects, anti-inflammatory/ immune modulating properties.

  Anti-oxidants (SAMe, silymarin)

  Supportive care if sick - IVFT, +/- potassium, glucose, analgesia especially if triaditis.

  Enteral nutrition to avoid hepatic lipidosis as a complication - IBD/FCE diet or high protein critical care diet. Do not protein restrict.
• Lymphocytic cholangitis

  Best treatment not clear because underlying cause is not known.

  Corticosteroids (+/- chlorambucil as 2nd immune suppressant agent in cats).

  Antibiotic treatment - rule out infection if you can do diagnostics.

  Ursodeoxycholic acid

  Antioxidants (bile is a potent oxidising toxin in the liver) - SAMe, Vit E

  Enteral nutrition

  Supportive care
• Hepatic lipidosis

  Enteral feeding ASAP

  • Continue for 4-6 weeks.

  Anti-emetics +/- prokinetics

  • Maropitant, metoclopramide
  • Ranitidine

  IVFT

  • Monitor potassium and glucose.

  Anti-oxidants

  Vitamin K - if any evidence of coagulopathy

  Treat the underlying cause/ concurrent disease.